Arthrofibrosis of the knee is a complication of injury or surgery where an excessive scar tissue response leads to painful restriction of knee motion, with early adhesions and later scar tissue forming within the joint and soft tissue spaces, and persisting despite routine rehabilitation exercises and stretches.

normal knee, before onset of arthrofibrosis sites of arthrofibrosis in the knee Advanced arthrofibrosis of the knee
Side view of section through a normal knee, where there are no adhesions locking up movement. Adhesions developing in the suprapatellar pouch, posterior capsule and anterior interval may create flexion loss, extension loss or both. Matured scar tissue has contracted, closing the important spaces that normally allow movement, and pulling the kneecap right down.

 

Rehabilitation issues with arthrofibrosis

Range of motion problems in early arthrofibrosis can be reversed with empathetic management - progressing patellar mobilisation and range of motion exercises in combination with adequate pain relief without pushing the joint into painful inflammation that makes things worse. Manipulation under anaesthesia may help to break adhesions before they become permanent scar tissue. Advanced arthrofibrosis may need surgical lysis of adhesions to regain range of motion, in combination with specialist pain management and physiotherapy.

 

Arthrofibrosis and patella baja (patella infera)

As the soft tissues behind and below the kneecap (patella) become involved in the scar tissue process, the kneecap may be pulled into an abnormally low position (patella baja) which may result in considerable pain with walking.

Synonyms: 
Adhesions
Internal scarring
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Article about the place of revision arthroplasty after failure of primary arthroplasty due to arthrofibrosis.

A video from one of our courses, discussing those knee conditions that may be complicated by knee stiffness.

Video with transcription.

The Anatomy of Knee Flexibility

A course explaining how the knee can become stiff.

An overview of the common surgical managements for arthrofibrosis, and their effectiveness.

A clinician anonymously discusses their own experiences with arthrofibrosis after a knee injury.

Highlighting forum discussion about arthrofibrosis

Pages

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CLINICAL PUBLICATIONS

Open debridement and soft tissue release as a salvage procedure for the severely arthrofibrotic knee.. Millett PJ, Williams RJ 3rd, Wickiewicz TL. Am J Sports Med. 1999 Sep-Oct;27(5):552-61.

The role of capsular distention in the arthroscopic management of arthrofibrosis of the knee: A technical consideration. Millett PJ, Steadman JR. Arthroscopy. 2001 Sep;17(7):E31.

Treatment of Knee Arthrofibrosis and Quadriceps Insufficiency after Patellar Tendon Repair: A Case Report Including Use of the Graston Technique. Black D. Int J Ther Massage Bodywork. 2010; 3(2): 14–21.


See also


list of surgeons with expertise in arthrofibrosis management

Who's Who in Arthrofibrosis Surgery?


eBook on patella baja in relation to arthrofibrosis

Arthrofibrosis and patella baja - ebook


eBook about mobilising the patella to regain range of motion of the knee

How to perform Patellar Mobilisations - ebook


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Kindle eBook - Authors: Frank Noyes & Sue Barber-Westin

Knee Arthrofibrosis: Everything You Need to Know to Recognize, Treat, and Prevent Loss of Knee Motion After Injury or Surgery

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